Varicose veins affect around 25 to 33 % of women and 10 to 20 % of men in Quebec - a considerable prevalence that makes chronic venous insufficiency one of the most widespread vascular conditions in the adult population. Beyond the aesthetic dimension often put forward, varicose veins represent a real medical condition that can lead to significant symptoms - heavy, painful legs at the end of the day, nocturnal cramps, ankle edema, itchy skin - and, in the long term, serious complications such as superficial thrombophlebitis, venous ulcers and lipodermatosclerosis.
Phlebology is the medical specialty dedicated to the diagnosis and treatment of venous diseases. Advances over the past two decades have transformed the way varicose veins are treated: today, treatments are far less invasive than in the past, and can be performed on an outpatient basis without the need for general anaesthesia or hospitalization, with excellent aesthetic and functional results and very little after-effects. This guide presents the treatment options available in Quebec in 2026, their respective indications, and what to expect during a phlebological consultation.
Understanding varicose veins: mechanisms and risk factors
The venous system of the lower limbs comprises a superficial network - visible under the skin - and a deep network - located in the muscle masses. Venous return to the heart takes place against gravity, thanks to unidirectional valves that prevent blood reflux. When these valves become deficient - through degeneration of the vein wall, genetic factors, or chronically high venous pressure - blood accumulates in the superficial veins, which gradually dilate to form varicose veins. Telangiectasias - fine red or purple veins visible on the surface, commonly known as «spider veins» - represent the most superficial stage of venous insufficiency.
The main risk factors for varicose veins include heredity - the risk is multiplied by three to four in the presence of a first-degree family history -, the female sex - female hormones and pregnancy weaken the vein wall -, pregnancy - compression of the inferior vena cava and increased blood volume create venous hypertension -, prolonged standing or sitting, obesity, age, and a sedentary lifestyle. If left untreated, varicose veins tend to progress over time, which is why it's important to treat them before complications arise.
Sclerotherapy: the reference treatment for varicose veins and telangiectasias
Sclerotherapy is the most widely used technique for treating varicose veins in outpatient phlebology, and is the reference treatment for telangiectasias, varicosities and reticular varicose veins of small and medium caliber. It involves injecting a sclerosing solution (polidocanol or sodium tetradecyl sulfate) into the pathological vein, causing controlled chemical irritation of the vein wall, leading to progressive fibrosis and disappearance within a few weeks. The procedure is performed in consultation, without anesthesia, using very fine needles. A slight burning sensation may occur during injection, but the procedure is generally well tolerated.
Foam sclerotherapy is a variant technique in which the sclerosing agent is mixed with air to form a foam that temporarily replaces the blood in the treated vein, improving contact between the agent and the vein wall. This technique is particularly effective for larger varicose veins. Results are progressive - two to six weeks for telangiectasias, a few months for larger varicose veins. Several sessions are often necessary for optimal results. Compression stockings should be worn after the treatment to promote venous healing.
Laser and other techniques for fine telangiectasia
The vascular laser - in particular the Nd:YAG 1064 nm laser - is a complementary option to sclerotherapy for the treatment of very fine telangiectasias, facial veins, or small spider veins resistant to sclerosis. Light energy is selectively absorbed by hemoglobin in the blood vessel, causing thermal photocoagulation that destroys the vein wall without affecting surrounding tissue. The procedure is rapid, with no need for injections, but may require several sessions. A sensation of intense, transient heat is experienced during laser pulses. Treated areas may experience redness and slight edema for a few hours to a few days.
Phlebological assessment and consultation procedure
All phlebological treatment begins with a medical assessment. The doctor takes a history of the symptoms - how long they have been present, how they have developed, their functional impact - family history, risk factors, and treatments already tried. The clinical examination assesses the distribution and stage of varicose veins according to the CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification, ranging from asymptomatic telangiectasias at stage C1 to active ulcers at stage C6. A venous Doppler ultrasound of the lower limbs is essential prior to any treatment of larger varicose veins - it maps the venous network, identifies pathological reflux at the saphenofemoral and saphenopopliteal junctions, and guides the treatment strategy.
On the basis of this assessment, the physician proposes a personalized treatment plan, which may combine several techniques depending on the type and distribution of the varicose veins. The treatment strategy generally begins by treating the most proximal sources of reflux - deficient large saphenous veins - before treating collateral branches and telangiectasias. Treating only small superficial veins without correcting reflux at the saphenofemoral junction runs the risk of early recurrence.
Frequently asked questions about phlebology and varicose vein treatment in Quebec
Is varicose vein treatment covered by RAMQ?
RAMQ coverage depends on the medical context and type of treatment. Medical consultations for the evaluation of symptomatic venous insufficiency - painful, with skin complications - may be covered by RAMQ. On the other hand, sclerotherapy treatments for telangiectasias for purely aesthetic purposes are not covered and are billed as private services. Surgical or interventional treatment of large varicose veins with documented functional impairment may be covered by the public network - but access times are often long. Using a private clinic allows rapid access to assessment and treatment, with transparent fees communicated at the time of consultation.
Can varicose veins come back after treatment?
Successfully treated varicose veins do not return to the same vein - the treated vein is permanently destroyed or closed. However, venous insufficiency is a chronic condition linked to genetic predisposition and persistent risk factors. New varicose veins can develop in other veins over time, especially if risk factors - prolonged standing, overweight, sedentary lifestyle - remain unchanged. Regular wearing of compression stockings, physical activity and weight control are the most effective preventive measures for slowing the progression of venous disease and prolonging the results of treatment.
Can varicose veins be treated during pregnancy?
No - sclerotherapy and other phlebological treatments are contraindicated during pregnancy and breastfeeding. Pregnancy is a period when varicose veins often progress markedly, due to hormonal changes and pelvic venous compression. Compression therapy (adapted compression stockings), leg elevation and moderate physical activity are the only interventions recommended during pregnancy. It is advisable to wait until the end of breastfeeding and post-partum hormonal stabilization - generally three to six months after delivery - before considering phlebological treatment. Many varicose veins that appear during pregnancy partially regress after delivery.
Can I consult in phlebology at several of your branches in Quebec?
Yes, Clinique Omicron offers phlebology consultations at several of its locations in Quebec. The initial assessment includes a clinical examination and venous Doppler ultrasound, followed by a personalized treatment plan. Sclerotherapy sessions are scheduled according to the number of areas to be treated and the extent of venous insufficiency. Fees vary according to the type of treatment and number of sessions - a precise estimate is provided during the initial consultation. These services are generally not covered by RAMQ for purely aesthetic indications, and some group insurance plans may provide partial coverage for treatments with documented medical indications.
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